Table 2. Selected guideline... | American Society of Hematology

Table 2.

Selected guideline recommendations for contraception for individuals with blood conditions

	Centres for Disease Control and Prevention Medical Eligibility Criteria 2024⁴⁶	ASH guidelines for management of venous thromboembolism: thrombophilia testing (2023)⁴⁸	EULAR recommendations for the management of family planning, assisted reproduction, pregnancy, and menopause in patients with SLE and/or APS (2017)⁵¹	British Society for Haematology guideline for management of SCD in pregnancy (2021)⁶²	National Heart, Lung, and Blood Institute evidence-based management of SCD (2014)⁶¹
General counseling	-	For women from the general population who are considering using COCs, the ASH guideline panel recommends not per- forming thrombophilia testing to guide the use of COCs.	Women with SLE should be counseled about the use of effective contraceptive measures (oral contraceptives, subcutaneous implants, IUD), based on their disease activity and thrombotic risk (particularly aPL status).	Pregnancy and conception should be discussed with women of childbearing age with SCD as part of their annual review. Contraceptive advice should be given and conveyed to the woman's primary care team.	As a part of primary care visits, provide risk assessment and educational and health promotion counseling (or refer to individuals with expertise in these disciplines) to all women and men of childbearing age to reduce reproductive risk and improve pregnancy outcomes. Provide contraceptive counseling, if desired, to prevent unintended pregnancy, and if pregnancy is desired, provide preconception counseling.
Contraceptive therapy guidance	Family history (1st- degree relative): no restriction (method can be used) for LNG IUD, implant, DMPA, POP; for CHC advantages generally outweigh theoretical or proven risks. For known thrombogenic mutations: For LNG IUD, Implant, POP advantages generally outweigh theoretical or proven risks; DMPA theoretical or proven risks usually outweigh advantages; CHC unacceptable health risk (method not to be used). SLE with positive (or unknown) aPLs: For LNG IUD, Implant, POP advantages generally outweigh theoretical or proven risks; DMPA theoretical or proven risks usually outweigh advantages; CHC unacceptable health risk (method not to be used). SLE with thrombocytopenia: All method's advantages generally outweigh theoretical or proven risks except for initiation of DMPA as theoretical or proven risks usually outweigh the advantages. SLE on immunosuppressive therapy: All methods advantages generally outweigh theoretical or proven risks. SLE and none of the above: All method's advantages generally outweigh theoretical or proven risks. SCD: no restriction (method can be used) for LNG IUD, Implant, POP; DMPA may be either advantages generally outweigh theoretical or proven risks OR theoretical or proven risks usually outweigh advantages (category should be assessed according to the severity of the condition and risk of thrombosis); CHC unacceptable health risk (should not be used).	For women with a family history of VTE and unknown thrombophilia status in the family who are considering using COCs, the ASH guideline panel suggests not testing for hereditary thrombophilia (using a panel of tests) to guide the use of COCs. For women with a family history of VTE and known FVL or PGM in the family (low-risk thrombophilia), the ASH guideline panel suggests not testing for the known familial thrombophilia to guide the use of COCs. For women with a family history of VTE and known AT, PC, or PS deficiency in the family (high-risk thrombophilia), the ASH guideline panel suggests testing for the known familial thrombophilia. The panel suggests avoidance of COCs for women with high-risk thrombophilia	IUD can be offered to all the patients with SLE and/or APS free of any gynecological contraindication.	The choice of contraception should be individualized but methods that eliminate user failure, such as LNG IUS and intramuscular DMPA, are preferred. There is some evidence for reduction in sickle pain associated with progesterone-only preparations. CHCs are an option for women with SCD but cardiovascular risk factors should be minimized to mitigate potential risk.	Progestin-only contraceptives (pills, injections, and implants), LNG IUDs, and barrier methods have no restrictions or concerns for use in women with SCD. If the benefits are considered to outweigh the risks, CHCs (pills, patches, and rings) may be used in women with SCD.

	Centres for Disease Control and Prevention Medical Eligibility Criteria 2024⁴⁶	ASH guidelines for management of venous thromboembolism: thrombophilia testing (2023)⁴⁸	EULAR recommendations for the management of family planning, assisted reproduction, pregnancy, and menopause in patients with SLE and/or APS (2017)⁵¹	British Society for Haematology guideline for management of SCD in pregnancy (2021)⁶²	National Heart, Lung, and Blood Institute evidence-based management of SCD (2014)⁶¹
General counseling	-	For women from the general population who are considering using COCs, the ASH guideline panel recommends not per- forming thrombophilia testing to guide the use of COCs.	Women with SLE should be counseled about the use of effective contraceptive measures (oral contraceptives, subcutaneous implants, IUD), based on their disease activity and thrombotic risk (particularly aPL status).	Pregnancy and conception should be discussed with women of childbearing age with SCD as part of their annual review. Contraceptive advice should be given and conveyed to the woman's primary care team.	As a part of primary care visits, provide risk assessment and educational and health promotion counseling (or refer to individuals with expertise in these disciplines) to all women and men of childbearing age to reduce reproductive risk and improve pregnancy outcomes. Provide contraceptive counseling, if desired, to prevent unintended pregnancy, and if pregnancy is desired, provide preconception counseling.
Contraceptive therapy guidance	Family history (1st- degree relative): no restriction (method can be used) for LNG IUD, implant, DMPA, POP; for CHC advantages generally outweigh theoretical or proven risks. For known thrombogenic mutations: For LNG IUD, Implant, POP advantages generally outweigh theoretical or proven risks; DMPA theoretical or proven risks usually outweigh advantages; CHC unacceptable health risk (method not to be used). SLE with positive (or unknown) aPLs: For LNG IUD, Implant, POP advantages generally outweigh theoretical or proven risks; DMPA theoretical or proven risks usually outweigh advantages; CHC unacceptable health risk (method not to be used). SLE with thrombocytopenia: All method's advantages generally outweigh theoretical or proven risks except for initiation of DMPA as theoretical or proven risks usually outweigh the advantages. SLE on immunosuppressive therapy: All methods advantages generally outweigh theoretical or proven risks. SLE and none of the above: All method's advantages generally outweigh theoretical or proven risks. SCD: no restriction (method can be used) for LNG IUD, Implant, POP; DMPA may be either advantages generally outweigh theoretical or proven risks OR theoretical or proven risks usually outweigh advantages (category should be assessed according to the severity of the condition and risk of thrombosis); CHC unacceptable health risk (should not be used).	For women with a family history of VTE and unknown thrombophilia status in the family who are considering using COCs, the ASH guideline panel suggests not testing for hereditary thrombophilia (using a panel of tests) to guide the use of COCs. For women with a family history of VTE and known FVL or PGM in the family (low-risk thrombophilia), the ASH guideline panel suggests not testing for the known familial thrombophilia to guide the use of COCs. For women with a family history of VTE and known AT, PC, or PS deficiency in the family (high-risk thrombophilia), the ASH guideline panel suggests testing for the known familial thrombophilia. The panel suggests avoidance of COCs for women with high-risk thrombophilia	IUD can be offered to all the patients with SLE and/or APS free of any gynecological contraindication.	The choice of contraception should be individualized but methods that eliminate user failure, such as LNG IUS and intramuscular DMPA, are preferred. There is some evidence for reduction in sickle pain associated with progesterone-only preparations. CHCs are an option for women with SCD but cardiovascular risk factors should be minimized to mitigate potential risk.	Progestin-only contraceptives (pills, injections, and implants), LNG IUDs, and barrier methods have no restrictions or concerns for use in women with SCD. If the benefits are considered to outweigh the risks, CHCs (pills, patches, and rings) may be used in women with SCD.

aPLs, antiphospholipid antibodies; EULAR, European Alliance of Associations for Rheumatology; SLE, systemic lupus erythematosus.